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      Transcranial Direct Current Stimulation Combined with Treadmill Gait Training in Delayed Neuro-psychomotor Development

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          Abstract

          [Purpose] The aim of the present study was to describe the results of transcranial direct current stimulation combined with treadmill training in a child with delayed neuro-psychomotor development. [Subject and Methods] Transcranial direct current stimulation (intensity: 1 mA) was applied over the primary motor cortex for 20 minutes during simultaneous treadmill training (2.5 km/h) in ten sessions. [Results] Clinically significant improvement was found in motor development (fine motor subscale, 23 to 25; gross motor subscale, 32 to 41). Reductions in mean oscillation of the center of pressure were found in the anteroposterior (239.2 to 146.5 mm) and mediolateral (177.4 to 149.2 mm) directions. Increases occurred in cadence (106 to 123 steps/minute), step length (0.16 to 0.23 m), step width (0.09 to 0.14 m) and gait velocity with support (0.3 to 0.7 m/s). [Conclusion] After treatment, the child was able to initiate the standing position for the first time and walk without support.

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          Cerebral location of international 10-20 system electrode placement.

          Richard Homan, John Herman, Phillip Purdy (1987)
          We employed CT scanning to correlate scalp markers placed according to the international 10-20 system with underlying cerebral structures. Subjects were 12 normal volunteers. Measurements included assessment for cranial asymmetry to determine the effect of skull asymmetry on cortical location of electrodes. Results were correlated with the cortical histological map of Brodmann. Primary cortical locations agree well with previously published data and provide cortical localization in greater detail than previous studies. Variability of cortical electrode location was substantial in some cases and not related to cranial asymmetry. The results indicate that CT scanning or other neuroimaging techniques which reveal detailed cerebral anatomy would be potentially highly useful in defining the generators of electrocerebral potentials recorded from the scalp.
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            Systematic Review of Parameters of Stimulation, Clinical Trial Design Characteristics, and Motor Outcomes in Non-Invasive Brain Stimulation in Stroke

            Bamidele O. Adeyemo, Marcel Simis, Debora Macea … (2012)
            Introduction/Objectives: Repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation are two powerful non-invasive neuromodulatory therapies that have the potential to alter and evaluate the integrity of the corticospinal tract. Moreover, recent evidence has shown that brain stimulation might be beneficial in stroke recovery. Therefore, investigating and investing in innovative therapies that may improve neurorehabilitative stroke recovery are next steps in research and development. Participants/Materials and Methods: This article presents an up-to-date systematic review of the treatment effects of rTMS and tDCS on motor function. A literary search was conducted, utilizing search terms “stroke” and “transcranial stimulation.” Items were excluded if they failed to: (1) include stroke patients, (2) study motor outcomes, or (3) include rTMS/tDCS as treatments. Other exclusions included: (1) reviews, editorials, and letters, (2) animal or pediatric populations, (3) case reports or sample sizes ≤2 patients, and (4) primary outcomes of dysphagia, dysarthria, neglect, or swallowing. Results: Investigation of PubMed English Database prior to 01/01/2012 produced 695 applicable results. Studies were excluded based on the aforementioned criteria, resulting in 50 remaining studies. They included 1314 participants (1282 stroke patients and 32 healthy subjects) evaluated by motor function pre- and post-tDCS or rTMS. Heterogeneity among studies’ motor assessments was high and could not be accounted for by individual comparison. Pooled effect sizes for the impact of post-treatment improvement revealed consistently demonstrable improvements after tDCS and rTMS therapeutic stimulation. Most studies provided limited follow-up for long-term effects. Conclusion: It is apparent from the available studies that non-invasive stimulation may enhance motor recovery and may lead to clinically meaningful functional improvements in the stroke population. Only mild to no adverse events have been reported. Though results have been positive results, the large heterogeneity across articles precludes firm conclusions.
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              Improved gait after repetitive locomotor training in children with cerebral palsy.

              Cordula Werner, Stefan Hesse, Paola Bonetti … (2011)
              The aim of this study was to evaluate the effectiveness of repetitive locomotor training with an electromechanical gait trainer in children with cerebral palsy. In this randomized controlled trial, 18 ambulatory children with diplegic or tetraplegic cerebral palsy were randomly assigned to an experimental group or a control group. The experimental group received 30 mins of repetitive locomotor training with an applied technology (Gait Trainer GT I) plus 10 mins of passive joint mobilization and stretching exercises. The control group received 40 mins of conventional physiotherapy. Each subject underwent a total of 10 treatment sessions over a 2-wk period. Performance on the 10-m walk test, 6-min walk test, WeeFIM scale, and gait analysis was evaluated by a blinded rater before and after treatment and at 1-mo follow-up. The experimental group showed significant posttreatment improvement on the 10-m walk test, 6-min walk test, hip kinematics, gait speed, and step length, all of which were maintained at the 1-mo follow-up assessment. No significant changes in performance parameters were observed in the control group. Repetitive locomotor training with an electromechanical gait trainer may improve gait velocity, endurance, spatiotemporal, and kinematic gait parameters in patients with cerebral palsy.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Phys Ther Sci
                Journal ID (iso-abbrev): J Phys Ther Sci
                Journal ID (publisher-id): JPTS
                Title: Journal of Physical Therapy Science
                Publisher: The Society of Physical Therapy Science
                ISSN (Print): 0915-5287
                ISSN (Electronic): 2187-5626
                Publication date (Electronic): 30 June 2014
                Publication date (Print): June 2014
                Volume: 26
                Issue: 6
                Pages: 945-950
                Affiliations
                [1) ] Rehabilitation Sciences, University Nove de Julho, Pediatric Neurosurgical Center (CENEPE), Brazil
                [2) ] Neurosciences and Behavior, Psychology Institute, University of São Paulo, Brazil
                [3) ] Rehabilitation Sciences, University Nove de Julho, Brazil
                [4) ] Pediatric Neurosurgery, University Federal de São Paulo, Brazil
                [5) ] Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, USA
                Author notes
                [* ]Corresponding Author. Luanda André Collange Grecco, Rehabilitation Sciences, University Nove de Julho, Pediatric Neurosurgical Center (CENEPE): Rua Diogo de Faria 775, Vila Mariana, CEP 04037-000, São Paulo, SP, Brazil. (E-mail: luandagrecco@ 123456hotmail.com )
                Article
                Publisher ID: jpts-2013-566
                DOI: 10.1589/jpts.26.945
                PMC ID: 4085227
                PubMed ID: 25013302
                SO-VID: c80a5de4-69f3-4b9b-8544-7897328a4b93
                Copyright © 2014©by the Society of Physical Therapy Science
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives (by-nc-nd) License.

                History
                Date received : 03 December 2013
                Date accepted : 08 January 2014
                Categories
                Subject: Case Study

                Keywords: child,gait,motor cortex,electrical stimulation
                Data availability:
                Keywords: child, gait, motor cortex, electrical stimulation

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